Abstract

A 49-year-old woman with rheumatoid arthritis (RA) and comorbid fibromyalgia presented to the clinic in extreme pain, described to be a 10 on an 11-point pain intensity numerical rating scale (PI-NRS). Because the patient also met the diagnostic criteria for fibromyalgia and conventional medications did not achieve adequate pain control for either condition, the off-label use of intravenous (IV) ketamine was presented as an alternative therapeutic option. The patient underwent 10 consecutive IV infusion sessions with increasing doses of ketamine hydrochloride without any complications. Following the 10th infusion, the patient reported that her pain was virtually non-existent (PI-NRS 0 - 1).